A.3 Use of diffusion-weighted imaging to distinguish seizure-related
                        change from limbic encephalitis

Background: Limbic encephalitis (LE) classically causes medial temporal lobe T2-hyperintensity on magnetic resonance imaging (MRI), but this can also occur with seizure activity. Identifying neuroimaging patterns that can distinguish between LE and seizure activity may help avoid diagnostic confusion in such challenging cases. Methods: Through retrospective review of Mayo Clinic patients who had medial temporal lobe T2-hyperintensity on MRI, we identified non-LE patients with seizure-related medial temporal lobe T2-hyperintensity. Their diffusion-weighted imaging (DWI) was reviewed to look for diffusion restriction patterns potentially unique to seizure activity. Next, a control cohort of LE patients with medial temporal lobe T2-hyperintensity was identified, and their DWI was reviewed to see if these diffusion restriction patterns could help distinguish seizure activity from LE. Results: We identified 10 non-LE patients who had medial temporal lobe T2-hyperintensity due to seizure activity; 9/10 had one of two medial temporal lobe diffusion restriction patterns we uncovered as being potentially unique to seizure activity. In contrast, only 5/57 LE patients had one of these diffusion restriction patterns identified, all of whom had seizures reported. Conclusions: We report two diffusion restriction patterns that may help distinguish seizure activity from LE. Recognition of these diffusion restriction patterns should prompt evaluation for possible seizure activity.

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Use of diffusion-weighted imaging to distinguish seizure-related change from limbic encephalitis

Journal of Neurology ◽

10.1007/s00415-020-10007-1 ◽

2020 ◽

Vol 267 (11) ◽

pp. 3337-3342 ◽

Cited By ~ 1

Author(s):

Adrian Budhram ◽

Jeffrey W. Britton ◽

Greta B. Liebo ◽

Divyanshu Dubey ◽

Anastasia Zekeridou ◽

...

Keyword(s):

Diffusion Weighted Imaging ◽

Limbic Encephalitis ◽

Diffusion Weighted

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The value of interictal diffusion-weighted imaging in lateralizing temporal lobe epilepsy

Neurology ◽

10.1212/01.wnl.0000250337.40309.3d ◽

2007 ◽

Vol 68 (2) ◽

pp. 122-127 ◽

Cited By ~ 30

Author(s):

T. Wehner ◽

E. LaPresto ◽

J. Tkach ◽

P. Liu ◽

W. Bingaman ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Diffusion Weighted Imaging ◽

Diffusion Weighted

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Detection of Low-Signal Pulvinar Areas Using Diffusion-Weighted Imaging in Patients with Dementia Experiencing Visual Hallucinations

Dementia and Geriatric Cognitive Disorders Extra ◽

10.1159/000449409 ◽

2016 ◽

Vol 6 (3) ◽

pp. 458-464 ◽

Cited By ~ 1

Author(s):

Mayuko Sugiura ◽

Masayuki Satoh ◽

Ken-ichi Tabei ◽

Tomoki Saito ◽

Mutsuki Mori ◽

...

Keyword(s):

Sex Education ◽

Diffusion Weighted Imaging ◽

University Hospital ◽

Visual Hallucinations ◽

Diffusion Weighted ◽

Evans Index ◽

Fluid Attenuated Inversion Recovery ◽

Magnetic Resonance Imaging Mri ◽

State Examination

Background: Little research has been conducted regarding the role of pulvinar nuclei in the pathogenesis of visual hallucinations due to the difficulty of assessing abnormalities in this region using conventional magnetic resonance imaging (MRI). The present study aimed to retrospectively investigate the relative abilities of diffusion-weighted imaging (DWI), fluid-attenuated inversion recovery (FLAIR), and susceptibility-weighted imaging (SWI) to visualize the pulvinar and to ascertain the relationship between pulvinar visualization and visual hallucinations. Methods: A retrospective analysis of 3T MRIs from 73 patients (31 males, 42 females; mean age 73.5 ± 12.7 years) of the Memory Clinic of Mie University Hospital was conducted. Correlations between pulvinar visualization and the following were analyzed: age, sex, education, hypertension, hyperlipidemia, diabetes mellitus, Mini-Mental State Examination score, Evans index, and visual hallucinations. Results: DWI detected low-signal pulvinar areas in approximately half of the patients (52.1%). Participants with pulvinar visualization were significantly older, and the pulvinar was more frequently visualized in patients who had experienced visual hallucinations compared to those who had not. No significant association was observed between whole brain atrophy and pulvinar visualization. Conclusions: The results of the present study indicate that diffusion-weighted 3T MRI is the most suitable method for the detection of pulvinar nuclei in patients with dementia experiencing visual hallucinations.

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Diffusion-Weighted Imaging in Oncology: An Update

Cancers ◽

10.3390/cancers12061493 ◽

2020 ◽

Vol 12 (6) ◽

pp. 1493 ◽

Cited By ~ 2

Author(s):

Carmelo Messina ◽

Rodolfo Bignone ◽

Alberto Bruno ◽

Antonio Bruno ◽

Federico Bruno ◽

...

Keyword(s):

Diffusion Weighted Imaging ◽

Water Molecules ◽

Non Invasive ◽

Diffusion Weighted ◽

Routine Magnetic Resonance Imaging ◽

Treatment Responses ◽

Magnetic Resonance Imaging Mri ◽

Almost All

To date, diffusion weighted imaging (DWI) is included in routine magnetic resonance imaging (MRI) protocols for several cancers. The real additive role of DWI lies in the “functional” information obtained by probing the free diffusivity of water molecules into intra and inter-cellular spaces that in tumors mainly depend on cellularity. Although DWI has not gained much space in some oncologic scenarios, this non-invasive tool is routinely used in clinical practice and still remains a hot research topic: it has been tested in almost all cancers to differentiate malignant from benign lesions, to distinguish different malignant histotypes or tumor grades, to predict and/or assess treatment responses, and to identify residual or recurrent tumors in follow-up examinations. In this review, we provide an up-to-date overview on the application of DWI in oncology.

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MRI findings and demographics of elastofibroma dorsi: assessment of diffusion-weighted imaging and contrast enhancement patterns

Acta Radiologica ◽

10.1177/0284185117732099 ◽

2017 ◽

Vol 59 (6) ◽

pp. 709-715 ◽

Cited By ~ 2

Author(s):

Maho Tsubakimoto ◽

Tsuneo Yamashiro ◽

Nanae Tsuchiya ◽

Masahiro Okada ◽

Hiroki Maehara ◽

...

Keyword(s):

Contrast Enhancement ◽

Signal Intensity ◽

Diffusion Weighted Imaging ◽

Enhancement Pattern ◽

Mri Findings ◽

Adc Value ◽

Diffusion Restriction ◽

Diffusion Weighted ◽

Elastofibroma Dorsi ◽

Significant Difference

Background Elastofibroma dorsi is a rare pseudotumoral lesion. Thus, there is no report of magnetic resonance imaging (MRI) findings that investigates multiple patients particularly with respect to diffusion-weighted imaging (DWI) findings and contrast enhancement patterns. Purpose To describe the imaging findings of elastofibroma on MRI, particularly DWI findings and contrast enhancement patterns, and to further investigate patient demographics. Material and Methods Forty-four patients with elastofibroma that underwent MRI were enrolled in this retrospective study. All images were evaluated by two radiologists to visually assess the signal intensity for each sequence. Enhanced elastofibromas were classified into four categories to assess the enhancement pattern. Differences in gender and laterality were also assessed statistically. Results An equal number of men and women were included (n = 22 each). There was no significant difference in laterality ( P = 0.783). All lesions (73 lesions) had low signal intensity on both T1-weighted (T1W) and T2-weighted (T2W) images: heterogeneous in 56, homogeneous in 17. None of the 41 lesions with DWI had true abnormal diffusion restriction. The average ADC value was 1.36 × 10–3 ± 0.29 mm2/s. All 31 lesions that had contrast-enhanced MRI were classified according to enhancement pattern: homogeneous (three lesions, 9.7%); heterogeneous (15 lesions, 48.4%); streak-like (three lesions, 9.7%); and rim-like (ten lesions, 32.2%). Conclusion There were no statistically significant differences in gender or laterality. Elastofibroma showed homogeneous to heterogeneous low signal intensity on T1W and T2W images. No lesion showed abnormal diffusion restriction, and all lesions demonstrated enhancement on MRI.

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Wallerian-Like Degeneration After Ischemic Stroke Revealed by Diffusion - Weighted Imaging

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100006120 ◽

2007 ◽

Vol 34 (2) ◽

pp. 243-244 ◽

Cited By ~ 8

Author(s):

P. N. Sylaja ◽

M. Goyal ◽

T. Watson ◽

M. D. Hill

Keyword(s):

Cerebral Artery ◽

Diffusion Weighted Imaging ◽

Acute Onset ◽

Cerebral Peduncle ◽

Diffusion Weighted ◽

Intravenous Tissue Plasminogen Activator ◽

Hyperintense Signal ◽

Apparent Diffusion ◽

Magnetic Resonance Imaging Mri ◽

The Right

A 22-year-old female was seen in the emergency within one hour of acute onset of right sided headache followed by weakness of the left side of body. On neurological examination, she was mildly drowsy, had forced right gaze deviation, dysarthria, left hemiplegia and left hemisensory loss. Computed tomography (CT) scan revealed early ischemic changes in the right middle cerebral artery (MCA) territory. The CT angiography done showed evidence of dissection of the supraclinoid segment of the right internal carotid artery with reduced flow distally into the MCA, which was confirmed by a conventional angiogram. In view of the intracranial carotid dissection, the patient was not treated with intravenous tissue plasminogen activator. Magnetic resonance imaging (MRI) of the brain done on the next day revealed evidence of acute ischemic lesions in the right MCA and anterior cerebral artery territory on diffusion-weighted imaging (DWI), with normal brainstem. [Figure 1] A repeat MRI performed 13 days after ictus showed hyperintense signal on DWI in the right cerebral peduncle which was hypointense on apparent diffusion coefficient (ADC) map suggestive of Wallerian-like degeneration. [Figure 2] The signal changes were less conspicuous on T2-weighted images. She had antigravity strength in the left leg but remained weak in her left arm at one month.

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Pitfalls of diffusion-weighted imaging of the female pelvis

Radiologia Brasileira ◽

10.1590/0100-3984.2016.0208 ◽

2018 ◽

Vol 51 (1) ◽

pp. 37-44 ◽

Cited By ~ 7

Author(s):

Ana Luisa Duarte ◽

João Lopes Dias ◽

Teresa Margarida Cunha

Keyword(s):

Signal Intensity ◽

Diffusion Weighted Imaging ◽

Structural Information ◽

Biological Tissues ◽

High Signal ◽

Female Pelvis ◽

Diffusion Weighted ◽

Apparent Diffusion ◽

Mri Sequences ◽

Magnetic Resonance Imaging Mri

Abstract Diffusion-weighted imaging (DWI) is widely used in protocols for magnetic resonance imaging (MRI) of the female pelvis. It provides functional and structural information about biological tissues, without the use of ionizing radiation or intravenous administration of contrast medium. High signal intensity on DWI with simultaneous low signal intensity on apparent diffusion coefficient maps is usually associated with malignancy. However, that pattern can also be seen in many benign lesions, a fact that should be recognized by radiologists. Correlating DWI findings with those of conventional (T1- and T2-weighted) MRI sequences and those of contrast-enhanced MRI sequences is mandatory in order to avoid potential pitfalls. The aim of this review article is the description of the most relevant physiological and benign pathological conditions of the female pelvis that can show restricted diffusion on DWI.

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LGI1 positive paraneoplastic limbic encephalitis: A case report of atypical presentation

Neurology Asia ◽

10.54029/2021auz ◽

2021 ◽

Vol 26 (4) ◽

pp. 865-867

Author(s):

Chien-Chung Cheng ◽

Jia-Ying Sung ◽

Chih-Shan Huang

Keyword(s):

Case Report ◽

Temporal Lobe ◽

Rectal Carcinoma ◽

Medial Temporal Lobe ◽

Limbic Encephalitis ◽

Memory Loss ◽

Atypical Presentation ◽

Paraneoplastic Limbic Encephalitis ◽

Sensory Aphasia ◽

Atypical Presentations

Limbic encephalitis is a rare disorder mainly affecting the medial temporal lobe and is classically paraneoplastic. Autoimmune etiologies also exist, such as antibodies against leucine-rich glioma activated 1 (LGI1). Most cases of anti-LGI1 encephalitis are not associated with tumors. Subacute memory loss is the predominant feature, and most patients develop focal seizures, especially faciobrachial dystonic seizures (FBDSs). Immunotherapies usually show a good response, but are less effective in paraneoplastic cases. We report a case of steroid-responsive anti-LGI1 encephalitis with atypical presentations of sensory aphasia during relapse from rectal carcinoma, an atypical site.

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